Gastroenterostomy for Gastric Outlet Obstruction in Patients Awaiting Neoadjuvant Chemotherapy

Gastric outlet obstruction (GOO) is a common and severe complication of resectable gastric cancer that impairs nutrition and prevents neoadjuvant chemotherapy (NACT), thereby worsening long-term outcomes. The criteria for choosing the optimal method to restore patency require further investigation. Objective. The aim of the study is to analyze current literature data on the efficacy of endoscopic stenting and gastroenterostomy (GES) for gastric outlet obstruction (GOO) in patients with resectable gastric cancer; to evaluate the impact of these surgeries on the feasibility of neoadjuvant chemotherapy (NACT) and subsequent radical surgical treatment; and to present our own clinical experience with GES formation. Materials and Methods. We analyzed current scientific literature – including retrospective studies, systematic reviews, and randomized controlled trials – on the efficacy of endoscopic gastric stenting and gastroenterostomy (GES) in resectable gastric cancer. We also report a clinical case series of GES for GOO performed prior to NACT and radical surgical resection. Results. The literature review demonstrated that GES formation provided longer symptom control and a significant reduction in the reintervention rate compared with gastric stenting. This technique is also associated with improved overall survival rates compared to upfront radical surgery. In our presented case series, no postoperative complications were reported following laparoscopic GES formation. All patients successfully completed the planned NACT and underwent radical surgery via distal gastrectomy. Histopathological examination revealed tumor regression grade 2 (Mandard TRG-2) in one patient, while the remaining cases demonstrated treatment response classified as Mandard TRG-3. Conclusion. Laparoscopic GES is a safe and highly effective method for correcting GOO in patients with resectable gastric cancer. It restores gastrointestinal transit, ensures NACT, and creates favorable conditions for subsequent radical surgery.